P1678: INTERVENTIONS AND THERAPY AT END OF LIFE IN HAEMATOLOGICAL MALIGNANCY: A RETROSPECTIVE COHORT STUDY ON HEALTHCARE UTILISATION
Authors: Briony Shaw, Catriona Parker, Jake Shortt, Stephen Opat, Peter Poon
Journal: HemaSphere (2023)

Topic: 35. Quality of life and palliative care Background: Patients with haematological malignancy (HM) have both treatment- and disease-related factors that increase rates of hospitalisations and invasive procedures. Complications of cytopenias including infection, bleeding and anaemia result in the frequent use of blood transfusions and antibiotics. Interventions and supportive care are still received by many patients close to the terminal phase of life, such as chemotherapy, invasive procedures and critical care admissions. Compared to solid organ malignancy, standardised quality end-of-life measures frequently differ in patients with HM. Aims: We aim to describe the healthcare utilisation and association of interventions with the intensity of HM therapy received prior to death. Methods: A retrospective cohort study of adult patients with HM who were deceased at a large Australian non-transplant tertiary hospital network (5 hospital sites and a patient catchment of 1.5 million people) was undertaken between Oct-2019 and Jul-2022. Data were extracted from medical records. Descriptive and univariate analysis was performed to assess associations between factors. Results: 229 patients met the inclusion criteria with a median age of 77 years, 65% male and 42% born in Australia. In the final 30 days of life 65% presented to the Emergency Department (ED), 22% had an Intensive Care Unit (ICU) admission, 22% had an invasive procedure, 48% received disease-modifying therapy (chemotherapy or targeted agents), 61% received red cells and 46% received a platelet transfusion. 74% were referred to the palliative care service, with median time from referral to death of 13 days. Of these, one third were referred within the last 5 days of life. Participation in a clinical trial within the last 30 days of life was associated with increased use of disease-modifying therapy (p=0.03), platelet transfusions (p=0.01) and ICU admissions (p=<0.01). Those receiving intensive chemotherapy (including salvage chemotherapy and autologous stem cell transplant) were more likely to be admitted to ICU (p=<0.01), spend their last 14 or 30 days of life in hospital (p=0.01, p=<0.01), were less likely to have a resuscitation limitation (p=<0.01), and trended towards dying in hospital (OR 1.78 [0.95-3.32] P=0.08). There was no significant difference between the treatment groups with likelihood of palliative care referral or location of death. Those receiving non-intensive therapy (i.e. azacitadine, lenalidomide) were more likely to receive therapy in the 7 days prior to death (p=<0.01), and be red cell (p=0.02) and platelet transfusion (p=0.04) dependent. However, these patients were less likely to die in the acute hospital setting (OR 0.58 [0.31-1.08], p=0.10). Those not receiving active therapy were more likely to have a resuscitation limitation documented (p=<0.01) and not be hospitalised before death (p=<0.01). These patients were more also likely to have been of a non-English speaking background (p=<0.01). Summary/Conclusion: Within our cohort of patients with HM we found high rates of hospitalisation and disease-modifying therapy use in the last month of life, corresponding with high rates of transfusion and critical care admissions. Clinical trial participation and intensive chemotherapy further corresponded with intense healthcare utilisation. Although most patients did receive a palliative care referral, this frequently occurred within days of death, potentially limiting the symptom and psychosocial benefits of this multidisciplinary service at end of life. Keywords: Quality of life, Hematological malignancy, Supportive care